Healthcare Provider Details

I. General information

NPI: 1336716430
Provider Name (Legal Business Name): KHANHLINH PHAN HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25316 74TH AVE S
KENT WA
98032-6022
US

IV. Provider business mailing address

25316 74TH AVE S
KENT WA
98032-6022
US

V. Phone/Fax

Practice location:
  • Phone: 800-562-8386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61451167
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: